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We read with great surprise the study conducted by Nesrin Şen et al. [1]. Many methodological errors in this study need to be pointed out. Firstly, some studies demonstrate that FMF disease is associated with various lung inflammatory diseases, such as spondyloarthritis (SpA), which can also cause fibrosis [2]. As a result, in this study, there is no difference between FMF patients with and without pulmonary fibrosis in terms of spondyloarthritis. That's the issue to pay attention to here. In other words, in this study, it was stated that spondyloarthritis, a disease that causes pulmonary fibrosis, accompanied FMF disease. And this was not reported in the control patients. In this case, the conclusion from this study is that the cause of pulmonary fibrosis is the concomitant diseases such as spondyloarthritis. Secondly, the methodological error is that, although it is stated that a single radiology doctor evaluated the lung tomographies, it is not mentioned whether intra-observer and inter-observer evaluations were performed. Thirdly, in this study, where lung damage is the outcome, the absence of a pulmonologist in this study is another limitation. In conclusion, since FMF progresses with acute, short-term attacks, it is unlikely to cause lung fibrosis [3]. Therefore, to reach such a conclusion, even accidentally, without resolving the concerns mentioned above, would be misleading for the scientific community.
References
Şen N et al (2023) Apical fibrosis was the most common incidental pulmonary finding in a familial Mediterranean fever cohort. Clin Rheumatol. https://doi.org/10.1007/s10067-023-06526-7
Atas N et al (2020) Familial Mediterranean fever is associated with a wide spectrum of inflammatory disorders: results from a large cohort study. Rheumatol Int 40(1):41–48. https://doi.org/10.1007/s00296-019-04412-7
Kelesoglu FM et al (2016) Evaluation of subclinical inflammation in familial Mediterranean fever patients: relations with mutation types and attack status: a retrospective study. Clin Rheumatol. https://doi.org/10.1007/s10067-016-3275-0
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Kelesoglu, F.M., Aygun, E. & Kelesoglu, F. Is apical lung fibrosis really associated with familial Mediterranean fever?. Clin Rheumatol 42, 1495 (2023). https://doi.org/10.1007/s10067-023-06561-4
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DOI: https://doi.org/10.1007/s10067-023-06561-4